July 8: Liverpool to Fairport, New York
July 8: Liverpool to Fairport, New York
Something weird is happening. Since the beginning of The Dream Tour on March 18, I’ve enjoyed a fairly flexible diet while I was riding on the bike. Today, my blood sugars during my ride were pretty good, but I accomplished that only because I ate almost nothing during my 5 and a half hour, 70 mile ride. Not good. Even worse is that this is a pattern that I started seeing two days ago when we left Utica.
On a typical ride in the past, I might eat a couple bagels, a couple bananas, some raisins, and a couple 10 ounce bottles of apple juice — roughly 300 grams of carbohydrates. This food along with a 40% reduction in my daytime basal rate would keep my blood sugars normal. Today’s 70 mile ride (at 40% reduction in basal rate), I had 710 milliliters of Gatorade (44 grams of carbohydrate), 5 ounces of apple juice (17 grams of carbohydrate) and one energy bar (43 grams of Carbohydrate). That’s about a third of my usual carbohydrate intake during a ride.
My blood sugars from today:
- 85 (5:50 AM) — fasting
- – (6:10 AM) — breakfast
- 74 (7:17 AM) — post breakfast — start of 40% basal rate reduction
- 123 (7:51 AM) — start of ride — drank 1/2 bottle of apple juice (17 grams of carbohydrate) — no bolus
- 160 (8:44 AM)
- 128 (10:11 AM) — 1/2 bottle of apple juice — bolused 0.5 units
- 55 (11:03 AM) — drank 355 mL of Gatorade (22 grams of carbohydrate) — no bolus
- 83 (12:13 PM) — lunchtime — drank 355 mL of Gatorade (22 grams of carbohydrate) plus ate 1 energy bar (43 grams of carbohydrate) — bolused 1.0 unit
- 107 (1:29 PM) — end of ride
What could be causing this drastic change in insulin requirements? Well, the usual suspect is my infusion site. My current site is one that I installed while in Utica two days ago. After two days of riding, it could be having troubles. So, after I showered today, I changed my site. Then I had a bagel, cheese, and mayo — something for which I’m quite good at bolusing for — to eat for lunch. An hour later (at 3:30 PM), I tested again and my blood sugar was 275. Hmmm. Maybe it wasn’t the site. I bolused a correction.
The other suspect is the insulin supply. Two days ago in Utica, I opened up a new bottle of insulin when I changed the insulin cartridge in my insulin pump. In 32 years of diabetes, I’ve never experienced a bottle of insulin that had gone bad, but there’s a first for everything. Once I started thinking along these lines, it started sounding plausible. There are two things that insulin doesn’t like: heat and being frozen. Insulin can be kept at room temperatures (below 86 degrees) for a limited time, but not indefinitely. It will lose potency the longer it stays at room temperature. I’m told that freezing insulin changes its chemical structure, rendering it totally ineffective.
I’ve been keeping my insulin in a sealed plastic bag in a cooler which we keep stocked with ice. We try to keep the insulin on top of the ice, but sometimes it gets buried. So, did the insulin freeze? Well, probably not because clearly my insulin is somewhat effective. If it had been rendered ineffective by freezing, I’d be telling you a much different story right now. This leaves the possibility that, despite our best efforts, my insulin supply has been compromised by temperatures warmer than they should be. This made even more sense when I look back at my basal rates over the last four months. Today, despite all the exercise I’m getting, my basal rates are 31% higher than at the start of the tour.
So, Pat and I talked about all this for a while and decided it was worth trying a new bottle of insulin. I have my prescriptions on file with one of those nationwide pharmacies, so I logged in to their site and put in a request for a refill on my insulin prescription. On their web site, you can specify which pharmacy you want pick up the prescription at. Luckily, there’s a branch about 15 miles from where we’re staying tonight.
We got back from the pharmacy at about 6 PM. I tested my blood sugar. 347. Oh boy! It took over an hour to get to the pharmacy and back, so my blood sugar should have come down rather than going up. I bolused another correction (5.0 units) and checked for ketones in my urine (a sign of ketoacidosis). No ketones. That’s good.
I proceeded to change my site AND the insulin cartridge. An hour later, my blood sugar was 104. For dinner, we had sandwiches and peaches that Pat had bought today at a grocery store. At 8:44 PM — an hour after dinner — my blood sugar was 92.
So, things seem to be back to normal. But, my struggles with this aren’t over. Because my basal rates are 31% higher now than 3 months ago, I’m wondering whether to lower them. I probably should, but by how much? I think I’m going to drop them almost all the way to the pre-tour levels and then plan to get up periodically overnight to test my blood sugar.
What a day!
Oh yes, I almost forgot. I did take some photos today. Here’s a link to them:
July 9th, 2006 at 5:52 am
You might have thought of it already, but is it possible that your tubing from your pump to your injectioin site is plugged up, making the flow if insulin inadequate. Do you use fresh (new) tubing often? Your analysis of the problem seems reasonable. Hope the problem is solved. M&D
July 9th, 2006 at 7:12 am
Wow a rough go with the insulin. There have been a few days when I have had a very similar thing happen to me. While I only inject NPH in the evening before bed it acts much like a basal injection. When I have had problems it is usually because of a slight infection, either stomach problems or the start of a cold light infection. Good luck finding what the source of your problem is. The pics are great..
July 9th, 2006 at 8:19 am
Hi Pete,
Knowing you and following your adventures has definately had an influence on me. I’ve recovered from my wreck and am commuting about 12 miles each way on my bike six days a week.
I’ve also become more sensitive to diabetics around me. Seeing people at work struggling with the disease and not excersizing and not carefully monitoring their diets is saddening. They just keep shooting and feeling worse and worse, gaining more and more weight.
I know it wouldn’t do any good for me to say anything, but I certainly understand more of what they’re going through.
So, many thanks to you, to Pat, and to the Dream Tour. You’ve touched my life.
John
July 9th, 2006 at 8:11 pm
Keep the faith Peter, you are touching people in ways you will never know. We spent yesterday with a couple who are long term friends (20 years) but we haven’t seen much over the years. They have a 19 year old son who is type 1 and was diagnosed at age 8. The young man is active (currently he rides bulls for sport) and played sports in high school. I told them about you and they were impressed and I told them about your web site.
As to the fence in your picture, if you had seen it in the South I would have said it was a game fence. That may be the case there too. Down here, owners sometimes fence in their properties with high, mesh, fences to keep in game (often exotics) and then sell hunts to would be sportmen. Not mine to judge, just a statement of fact and may be the reason for the fence you saw.
Robby